International Journal of Colorectal Disease

, Volume 30, Issue 9, pp 1275–1279 | Cite as

The impact of perianal disease in young patients with inflammatory bowel disease

  • Nathan P. Zwintscher
  • Puja M. Shah
  • Amit Argawal
  • Patrick M. Chesley
  • Eric K. Johnson
  • Christopher R. Newton
  • Justin A. Maykel
  • Scott R. SteeleEmail author
Original Article



Perianal disease is a potentially significant source of morbidity for patients with inflammatory bowel disease (IBD). We sought to identify the impact of perianal disease on IBD outcomes in children, adolescents, and young adults.


We studied 12,465 inpatient admissions for patients ≤20 years old with IBD in 2009 using the Kids’ Inpatient Database (KID). Patients were stratified by their principal diagnosis of ulcerative colitis (UC) or Crohn’s disease (CD). Perianal disease (perianal abscess, anal fissure, or anal fistula), complex fistulas (rectourethral, rectovaginal, or enterovesical), and growth failure were defined by ICD-9 codes. Logistic regression was performed adjusting for CD or UC, gender, age, need for surgical intervention, fistulas, or growth failure.


Of the 511 (4.1 %) patients with perianal disease, 480 had CD (94 %, p < 0.001). Girls were less likely to suffer perianal disease (OR = 0.63, CI 0.52–0.76, p < 0.001). Those with perianal disease were more likely to suffer complex fistulas (OR = 3.5, CI 1.98–6.20, p < 0.001) but less likely to suffer enteroenteral fistulas (OR = 0.30, CI 0.15–0.63, p = 0.001) than those without perianal disease. Perianal disease did not increase the incidence of growth failure (p = 0.997) but doubled the likelihood of an operation of any type during admission (p < 0.001). Additionally, patients with perianal disease spent on average 1.29 more days in the hospital (7.45 vs. 6.16 days, p < 0.001) and accrued $5838 extra in hospital charges (p = 0.005).


Perianal disease in younger patients is associated with a longer length of stay, higher hospital charges, and increased rates of both perineal and abdominal operative procedures. These data support the notion that, similar to adults, the presence of perianal disease in pediatric Crohn’s patients is associated with a more severe course.


Crohn’s disease Ulcerative colitis Fistula Pediatric IBD 



The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg (outside the USA) 2015

Authors and Affiliations

  • Nathan P. Zwintscher
    • 1
  • Puja M. Shah
    • 2
  • Amit Argawal
    • 3
  • Patrick M. Chesley
    • 1
  • Eric K. Johnson
    • 1
  • Christopher R. Newton
    • 4
  • Justin A. Maykel
    • 5
  • Scott R. Steele
    • 1
    Email author
  1. 1.Department of SurgeryMadigan Army Medical CenterTacomaUSA
  2. 2.University of Virginia Health SystemCharlottesvilleUSA
  3. 3.University of Texas Medical School-HoustonHoustonUSA
  4. 4.Children’s Hospital OaklandOaklandUSA
  5. 5.UMass Memorial Medical CenterWorcesterUSA

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